The use of mannitol and hypertonic saline solution in neurocritical patients varies considerably among centres and there is no consensus regarding which of the two is the agent of choice.

Finally, HTS is currently the preferred agent of a majority of neuro-intensivists, and it is associated with a more favorable side-eff ect profi le than mannitol. Regardless of the aetiology of IH, osmotherapy is one of the hipeertonica in the management of this disorder. Mannitol-induced acute renal failure.

Hyperosmolar therapy for intracranial hypertension. Aggravation of vasogenic cerebral edema by multiple-dose mannitol. There are no pharmacokinetic data on HTS, but Lazaridis suggests that the onset of the effects is similar to that of mannitol. Hypertonic saline and mannitol therapy in critical care neurology.

Introduction Several studies in animals and humans have demonstrated the efficacy of hyperosmolar agents in lowering ICP, produce plasma expansion, change the blood rheology and have antiinflamatorios. Two comprehensive reviews have summarized this evidence. Generally, intracerebral peritumoral oedema is vasogenic. Box Miami, Fl Schwartz 33 Estimated H-index: Together, these two studies [6,7] compile the results of 37 primary investigations, of which 11 represent class I evidence.

Of the 16 studies reviewed, including 4 prospective randomized studies and multiple observational studies, the data support the use hlpertonica HTS as an effective means to lower ICP in patients with TBI. Although the study grouped the patients for the majority of the characteristics measured, and although it is the largest study conducted in humans until in supratentorial tumours, it is worth nothing that it did not measure ICP routinely and it excluded patients with signs of IH.

Hypertonic saline versus mannitol for the treatment intracranial pressure: Formula para saolucion hipertonica Documents. The primary objective of these measures is to maintain adequate CBF in order to meet neuronal metabolic needs and prevent cerebral ischaemia.

Mannitol versus hypertonic saline solution in neuroanaesthesia

Enhancement of cerebral blood flow using systemic hypertonic saline therapy improves outcome in patients with poor-grade spontaneous subarachnoid hemorrhage. The immunomodulatory effects of hypertonic saline resuscitation in patients sustaining traumatic hemorrhagic shock: They did not find significant differences between the two agents, but the sample size is very small to allow a definitive conclusion.

They pointed out that the odds ratio for the control of intracranial hypertension was 1. In 11 studies, HTS infusion was used and the majority showed it to be effective for ICP control, but only 3 of those studies were prospective and randomized.

AbstractHyperosmolar therapy is the principal medical management strategy for elevated intracranial pressure. Fluid resuscitation in this population, particularly with HTS alone or combined with dextran, restores intravascular volume with less volumes, 73 increases CPP, lowers ICP, 74 and modulates the inflammatory response. P Visweswaran 1 Estimated H-index: While other preclinical and clinical studies report the use of mannitol, these nine studies represent the highest-quality clinical evidence on which the designation of mannitol as the gold-standard treatment for IH is based.

Of the 36, 12 compared mannitol with HTS: Cerebral hemodynamic and metabolic effects of equi-osmolar doses mannitol and Although varying in methodology, nine of the 12 studies including fi ve class I studies demonstrate that HTS provides superior control of ICP over mannitol [6].

Confl icts of interestThe author declares that he has no competing interests. However, 9 comparative studies, 7 of which were randomized prospective controlled studies, showed that HTS was better at controlling ICP than mannitol. HTS maintains systemic and cerebral haemodynamics. Intracerebral haemorrhage ICH Intracranial hypertension manittol during the acute phase of ICH and it is a predictor of poor prognosis in these patients.

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